Validation of Score to Detect Intracranial Lesions in Unconscious Patients in Prehospital Setting

OBJECTIVES: Recognizing stroke and other intracranial pathologies in prehospital phase facilitates prompt recanalization and other specific care. Recognizing these can be difficult in patients with decreased level of consciousness. We previously derived a scoring system combining systolic blood pressure, age and heart rate to recognize patients with intracranial pathology. In this study we aimed to validate the score in a larger, separate population. MATERIALS AND METHODS: We conducted a register based retrospective study on patients ≥16 years old and Glasgow Coma Score <15 encountered by helicopter emergency medical services. Diagnoses at the end of hospitalization were used to identify if patients had intracranial lesion or not. The performance of score was evaluated by area under the receiver operating characteristics curve (AUROC). RESULTS: Of 9,309 patients included, 1,925 (20.7%) had an intracranial lesion including 1,211 cases of stroke. Older age, higher blood pressure and lower heart rate were predictors for an intracranial lesion (P<0.001 for all). The score distinguished patients with intracranial lesion with AUROC of 0.749 (95% CI 0.737 to 0.761). The performance slightly improved if only patients intubated in prehospital phase were included AUROC 0.780 (95% CI 0.770 to 0.806) or convulsion related diagnosis excluded AUROC of 0.788 (95% CI 0.768 to 0.792). CONCLUSIONS: A scoring of systolic blood pressure, heart rate and age help differentiate intracranial lesions in patients with decreased level of consciousness in prehospital care. This may facilitate direct transportation to stroke center and application of neuroprotective measures in prehospital critical care.